MERLOT Materialshttps://www.merlot.org/
MERLOT MaterialsCopyright (C) 2018 MERLOT Some Rights ReservedFri, 14 Nov 2014 02:54:39 GMTMERLOThttps://www.merlot.org/merlot/images/merlot_column.pnghttps://www.merlot.org/
-1-1An Atlas of Diseases of the Kidneyhttps://www.merlot.org/merlot/viewMaterial.htm?id=86550
This site contains an extensive series of pages detailing all aspects of kidney disease. The site contains high resolution imagry of kidney tissue illustrative of the diseases discussed. The site also contains a series of PowerPoint presentations that follow each of the Chapters of the five books on kidney disease available online. This site is also searchable.Tue, 25 Apr 2006 07:00:00 GMTDr. Robert W. Schrier, Editor University of Colorado Medical SchoolDiabetic Foot Carehttps://www.merlot.org/merlot/viewMaterial.htm?id=377751
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode describes the foot problems that diabetic patients face and reviews guidelines for examining the feet of patients with diabetes and helping patients care for their feet. <em>Learning Objectives</em>: the physician audience should be able to: Describe recent statistics on amputation rates, foot examinations, and hospitalizations for feet problems related to diabetics; Correctly examine the feet of diabetic patients; Educate patients with diabetes on how to care for their own feet; and Prescribe foot care and shoes to meet medicare requirements</p><p><em>Podcast Pearl: </em>Reminders for reducing diabetic nephropathy (Dr. Jennifer Mitchell)</p><p>There is a supporting fact sheet available at: <a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf" target="_blank"></a><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf" target="_blank"><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf" target="_blank">http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf</a></a></p>Wed, 08 Apr 2009 01:56:13 GMTFiona Prabhu; Tommie Farrell Texas Tech Medical School; Texas Tech Medical SchoolFree Books for Doctorshttps://www.merlot.org/merlot/viewMaterial.htm?id=871173
<p>FreeBooks4Doctors goal is to freely promote online medical books/literature to doctors and those in the medical professions, so that these medical books/materials/resources can be widely available and easily accessible to find and download anywhere in the world.</p>Sun, 22 Jun 2014 13:43:16 GMTFree Books 4 Doctors Staff FreeBooks4Doctors, AmedeoHepatic and Biliary Disordershttps://www.merlot.org/merlot/viewMaterial.htm?id=384744
<p>This site is a section of the free Merck Online Manual that deals with Hepatic and Biliary Disorders. Some of the sub-topics include Fibrosis and Cirrhosis, Liver Masses and Granulomas, Vascular Disorders of the Liver and others. Each of the sub-topics has information about the problem, symptoms and treatment.</p>Tue, 26 May 2009 16:49:15 GMTMerckiSeek Medical Database Search Enginehttps://www.merlot.org/merlot/viewMaterial.htm?id=851128
<p>iSeek Medical Database Search Engine is designed for medical clinicians, faculty, and students to save them time in quickly finding high-quality, evidence-based, clinically-based resources for which they are searching. The iSeek Curriculum Intelligent Agent Tool allows medical students to quickly refine and pinpoint relevant, pertinent, and specific information about most medical related topic(s) queried, and also provides them with additional integated medical resources such as lectures, videos, and slides pertaining to the topic(s) queried. </p>Tue, 01 Apr 2014 23:25:31 GMTiSeek Medical Staff iSeeK(tm) Vantage Labs, LLCM1 Renal- Example Questions: Amino Acid lectureshttps://www.merlot.org/merlot/viewMaterial.htm?id=681254
This sequence addresses the various structural components in the kidney are specialized for processing of the filtrate and production of urine. It also covers homeostatic mechanisms involved in the control and regulation of fluid, electrolyte and acid-base balance, as well as metabolic processes in eliminating nitrogenous waste such as urea and uric acid.Fri, 10 Aug 2012 22:15:57 GMTRobert Lyons University of Michigan Medical SchoolMaintaining the Body's Chemistry: Dialysis in the Kidneyshttps://www.merlot.org/merlot/viewMaterial.htm?id=86548
<p>This site is a tutorial on kidney structure and function. The diagrams are well done and correlated with the function of each part of the kidney. Detailed descriptions of how water and ions are actually moved through the membrane channels are provided. Study questions are provided on membrane channels, diffusion and concentration gradients (including a video on movement of molecules during diffusion), and membranes and concentration gradients within the kidney. The tutorial concludes with a discussion of artificial kidney dialysis.</p>Tue, 25 Apr 2006 07:00:00 GMTRachel Casiday; Regina Frey Department of Chemistry, Washington University St. Louis, MO 63130; Department of Chemistry, Washington University St. Louis, MO 63130The Biology Project - Kidneys and Metalshttps://www.merlot.org/merlot/viewMaterial.htm?id=264682
Tutorials and quizzes covering "basic anatomy and physiology of the kidneys, properties of metals, and the effect of metals on the kidneys and on kidney cells." Part of "The Biology Project - Chemicals and Human Health", http://www.biology.arizona.edu.Thu, 26 Jul 2007 23:01:02 GMTRick Hallick; Bill Grimes Univeristy of Arizona; University of ArizonaUrinary Tract Infectionshttps://www.merlot.org/merlot/viewMaterial.htm?id=575906
<p>This site provides information to better understand causes, symptoms, and treatments for urinary tract infections.</p>Thu, 18 Aug 2011 03:26:53 GMTNational Kidney and Urologic Diseases Information ClearinghouseDiabetic Nephropathyhttps://www.merlot.org/merlot/viewMaterial.htm?id=377748
<p>&#34;The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care.&#34; &#34;This episode describes the natural history of diabetic nephropathy and includes a review of screening for diabetic nephropathy, prescribing treatment to reverse early kidney disease, and recommending dietary and supplemental therapy. <em>Learning Objectives</em>: the physician audience should be able to: Describe the natural history of diabetic neophropathy; Screen patients for diabetic nephropathy; Prescribe treatment for the reversal of early diabetic nephropathy; and Recommend dietary and nutritional supplemental therapy for diabetic nephropathy</p><p><em>Podcast Pearl: </em>Tips on how to reduce patients&#39; hemoglobin A1C levels by following up with pharmacists and patients to improve compliance. (Dr. Mike Ragain)</p>Wed, 08 Apr 2009 01:50:31 GMTRon Cook; MIke Ragain Texas Tech Medical School; Texas Tech Medical School10 Steps to Improved Glycemic Control (Part 2)https://www.merlot.org/merlot/viewMaterial.htm?id=377765
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode is the second of a 2-part podcast that addresses why it's important for your patient to achieve glycemic control and 5 ways to help them do it.<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: Explain the importance of helping patients achieve glycemic control Apply 5 more steps to improve patients' glycemic control:</p><p> 6. Don't wait to titrate</p><dl><dd>7. After 3 months, if patients are not at target HbA<sub>1</sub>C &lt; 6.5%, consider combination therapy </dd><dd>8. Initiate combination therapy or insulin immediately for all patients with HbA<sub>1</sub>C &gt; 9% at diagnosis </dd><dd>9. Use combinations of agents with different courses of action. </dd><dd>10. Use an interdisciplinary approach to diabetes management to encourage patient education and self-care </dd></dl><p>Use control therapies sooner to achieve target glucose levels more quickly Treat co-morbid conditions aggressively in patients with diabetes Take advantage of a team approach that includes other health care professionals and the patient's own disease management</p><p><em>Podcast Pearl: </em>Male patients with DM may experience erectile dysfunction, but may be too embarrassed to ask the physician about treatment options (Dr. Jack Dyer)</p><p>There is a Fact Sheet available at: <a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl2.pdf" target="_blank"></a><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl2.pdf" target="_blank"><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl2.pdf" target="_blank">http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl2.pdf</a></a></p>Wed, 08 Apr 2009 02:17:28 GMTJack Dyer; Mike Ragain Texas Tech Medical School; Texas Tech Medical School10 Steps to Improved Glycemic Control (Part I)https://www.merlot.org/merlot/viewMaterial.htm?id=377761
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode is the first of a 2-part podcast that addresses why it's important for your patient to achieve glycemic control and 5 ways to help them do it.<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: Explain the importance of helping patients achieve glycemic control Apply 5 steps to improve patients' glycemic control:</p><dl><dd>1. Aim for good glycemic control, defined as HbA<sub>1</sub>c &lt; 6.5%.Measure A<sub>1</sub>C every 3 months </dd><dd>2. Monitor HbA<sub>1</sub>C every 3 months in addition to regular glucose self-monitoring </dd><dd>3. Aggressively manage hyperglycemia, dyslipidemia and hypertension with the same intensity to obtain the best patient outcome </dd><dd>4. Recognize that DM is complicated and requires multiple treatments </dd><dd>5. Address the underlying pathophysiology, including treatment of insulin resistance </dd></dl><p>Use control therapies sooner to achieve target glucose levels more quickly; Treat co-morbid conditions aggressively in patients with diabetes; and Take advantage of a team approach that includes other health care professionals and the patient's own disease management</p><p><em>Podcast Pearl: </em>The bane of the diabetic patient: smoking (Dr. Mike Ragain)</p><p>There is also a Fact Sheet available at: <a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl1.pdf" target="_blank"></a><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl1.pdf" target="_blank"><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl1.pdf" target="_blank">http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMGlycControl1.pdf</a></a></p>Wed, 08 Apr 2009 02:13:20 GMTJack Dyer; Mike Ragain Texas Tech Medical School; Texas Tech Medical SchoolBenign Prostatic Hyperplasia-Lower Urinary Tract Symptoms: Improved Long-term Care of Patients With Erectile Dysfunctionhttps://www.merlot.org/merlot/viewMaterial.htm?id=830613
<p>This is a free textbook that is offered by Amazon for reading on a Kindle. Anybody can read Kindle books—even without a Kindle device—with the free Kindle app for smartphones and tablets. Download the app for your device and start reading for free.</p><p>'<span>This Clinical Resource Tool is structured around consensus statements developed by the BPH-LUTS±ED Expert Working Group, a panel of primary care physicians and urologists with expertise in the multidimensional care of patients with LUTS and sexual dysfunction. Using a modified Delphi process, the experts consolidated published evidence and expert clinical experience on critical issues involving salient phenomenology, comprehensive assessment and diagnosis, and formulation of appropriate initial and ongoing interdisciplinary care for patients with BPH-LUTS±ED. The consensus statements and accompanying resources are intended as a practical companion to current guidelines, to help clinicians individualize best-practice care for this heterogeneous patient population.'</span></p>Thu, 30 Jan 2014 00:24:51 GMTDavid R. Staskin MD, et al.Caring for Diabetic Patients: A Summaryhttps://www.merlot.org/merlot/viewMaterial.htm?id=378483
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This provides an summary of issues related to screening, lab tests and values, and preventive care for diabetic patients, as well as office systems that enhance care of diabetic patients<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: List lab screening tests and target values for diabetic patients; List preventive screenings and immunizations recommended for diabetic patients; Describe office systems that are important in improving care of diabetic patients; Provide effective care of patients with diabetes; and Perform continuing self-assessment and quality assurance regarding the care of diabetic patients</p>Sun, 12 Apr 2009 02:42:29 GMTMike Ragain; Ron Cook; Betsy Jones Texas Tech Medical School; Texas Tech Medical School; Texas Tech Medical SchoolChecking for A1C Levels for Diabeteshttps://www.merlot.org/merlot/viewMaterial.htm?id=378469
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode provides an overview of the importance of accurate A1C testing and point-of-care testing.<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: Explain the importance of accurate A1C testing and Describe point-of-care testing for diabetes</p><p><em>Podcast Pearl: </em>Reminder: Recommend a flu shot &amp; pneumovax for all diabetic patients (Dr. Ron Warnerl)"</p>Sun, 12 Apr 2009 02:18:40 GMTDoyle Cummings; Betsy Jones East Carolina University; Texas Tech Medical SchoolClinical Liver Disease App for iOShttps://www.merlot.org/merlot/viewMaterial.htm?id=908793
<p>'Clinical Liver Disease, the AASLD&rsquo;s digital learning resource is now available on your iPad and iPhone. Fresh from the newsstand, &ldquo;CLD&rdquo; brings you a a blended content delivery format incorporating audio, video, text, and other interactive learning activities to help you improve your care of the patient with liver disease. CLD lets you learn at your own pace, in the location of your choice. Access is free, and CME credit is available. The app lets you:<br /><br />- Be notified when new issues are available.<br />- Download articles and issues for offline perusal.<br />- Save your favorite articles for quick and easy access, online or offline.<br />- Share articles with colleagues or students.<br /><br />About the Journal<br /><br />Clinical Liver Disease (CLD) is an official digital learning publication of the American Association for the Study of Liver Diseases.<br /><br />This interactive, up-to-date source of education is designed for physicians and healthcare providers caring for the patient with liver disease. Access the full text, audio, and video content via the iPad app to receive current and clinically relevant information covering a range of hepatological diseases and conditions.<br /><br />With CLD, you&rsquo;ll never stop learning.'</p>
<p>This is a free app</p>Fri, 14 Nov 2014 02:54:39 GMTWiley PublishingControlling Blood Pressure for Diabetic Patientshttps://www.merlot.org/merlot/viewMaterial.htm?id=377771
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "In this episode, we eavesdrop on a patient visit between a family physician and a new patient who has Type 2 diabetes and high blood pressure; we'll hear about health complications from elevated blood pressure, as well as lifestyle and medication therapy to control it.<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: List the recommended blood pressure goals in diabetics; Explain the importance of blood pressure control for diabetics and the complications that may result from uncontrolled blood pressure; Recommend to diabetic patients the lifestyle changes that can help control blood pressure; and Prescribe appropriate medications for drug therapy</p><p><em>Podcast Pearl: </em>New techniques for assessing diabetic foot ulcers. Summary of a new article in <em>Diabetes Care.</em> (Dr. Tommie Farrell)"</p><p>There is also a Fact Sheet at: <a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMBlPressure.pdf" target="_blank"></a><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMBlPressure.pdf" target="_blank"><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMBlPressure.pdf" target="_blank">http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMBlPressure.pdf</a></a></p>Wed, 08 Apr 2009 02:29:38 GMTTommie Farrell Texas Tech Medical SchoolCultural Competency and Diabeteshttps://www.merlot.org/merlot/viewMaterial.htm?id=377773
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode addresses cultural competency and the importance of cultural sensitivity in interactions with patients who have diabetes..<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: Describe the significance of the physician's own medical culture in dealing with patients; Outline the cultural challenges that are unique to diabetes and diabetic patients; and Use the Kleinman Explanatory Model to help cope with patient and family needs as well as to interpret the culture of Western medicine to others</p><p><em>Podcast Pearl: </em>The importance of language issues and using translators to improve cultural competency (Dr. Arthur Islas)</p><p> </p>Wed, 08 Apr 2009 02:34:01 GMTArthur Islas Texas Tech Medical SchoolCurrent Issues and Future Direction in Kidney Transplantationhttps://www.merlot.org/merlot/viewMaterial.htm?id=736478
<p>This is a free online textbook offered by InTech.</p><p>'<span>The here presented book covers different areas of clinical and scientific interest, reaching from donor evaluation to newest methods in immunological diagnostics. But also aspects of daily care of transplant recipients can be found in the carefully selected chapters. Everything driven by the aim to improve the care for all of our transplanted patients.'</span></p>Wed, 27 Feb 2013 22:30:42 GMTThomas Rath, Editor Westpfalz-Klinikum, KaiserslauternDiabetes and Cardiovascular Diseasehttps://www.merlot.org/merlot/viewMaterial.htm?id=377759
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode outlines the link between DM and CVD, focusing on means for reducing the risk of further cardiovascular complications.<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: Describe the significance of the link between diabetes and cardiovascular complications; Identify the metabolic complications associated with diabetes; Associate the risks for cardiovascular complications in patients with diabetes with those in patients who have had a heart attack; and Assist diabetic patients in reducing their risk for further cardiovascular complications</p><p><em>Podcast Pearl: </em>The significance of the difference between microvascular disease and macrovascular disease in diabetes (Dr. Tom Tenner)</p><p>There is also a Fact Sheet at: <a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMCVD_DM.pdf" target="_blank"></a><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMCVD_DM.pdf" target="_blank"><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMCVD_DM.pdf" target="_blank">http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMCVD_DM.pdf</a></a></p>Wed, 08 Apr 2009 02:07:26 GMTTom Tenner Texas Tech Medical SchoolDiabetes and Stages of Changehttps://www.merlot.org/merlot/viewMaterial.htm?id=377754
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode outlines the stages of behavior change and discusses the importance of assessing patients' readiness for change, as is often required by a diagnosis of diabetes. </p><p><em>Learning Objectives</em>: the physician audience should be able to: Explain why behavior change is important to diabetic patients; Explain the stages of change model; Describe how the stages of change model is applicable to behavior change with diabetic patients; and Assist diabetic patients with appropriate behavior change</p><p><em>Podcast Pearl: </em>High intake of calcium &amp; vitamin D (particularly from supplements) may lower the risk of diabetes by 33% (Dr. Ron Cook)</p><p>There is an additional Fact Sheet available at: <a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf" target="_blank"></a><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf" target="_blank"><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf" target="_blank">http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMStageChange.pdf</a></a></p>Wed, 08 Apr 2009 02:02:14 GMTBetsy Jones; Lance Evans Texas Tech Medical School; Texas Tech Medical SchoolDiabetic Eye Diseasehttps://www.merlot.org/merlot/viewMaterial.htm?id=378466
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode provides an overview of diabetic retinopathy and diabetic eye disease.</p><p><em>Learning Objectives</em>: the physician audience should be able to: Define the terms "diabetic retinopathy" and "diabetic eye disease"; Screen diabetic patients for diabetic eye disease; and Refer patients to an ophthamologist for regular eye care</p><p><em>Podcast Pearl: </em>Screening recommendations for eye disease (Dr. Jennifer MItchell)"</p>Sun, 12 Apr 2009 02:13:10 GMTJennifer Mitchell; Kelly Mitchell Texas Tech Medical Center; Texas Tech Medical CenterDocumenting a Diabetic Visithttps://www.merlot.org/merlot/viewMaterial.htm?id=378479
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This provides an example of a diabetic patient visit and reminders about writing an effective SOAP note.<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: Explain special problems in documenting a chronic disease patient visit; List the key parts of documentation for a history of a chronic illness; and Write an effective SOAP note for a patient with diabetes</p>Sun, 12 Apr 2009 02:35:38 GMTTommie Farrell Texas Tech Medical CenterElements of a Diabetic Visithttps://www.merlot.org/merlot/viewMaterial.htm?id=377776
<p>"The Texas Tech Medcast is a podcast for medical residents, medical students, practicing physicians, and others involved in medical education and high quality, patient-centered primary care." "This episode addresses the purpose and elements of regular diabetes maintenance visits, as well as how to cover those elements in a time-efficient, yet patient-centered manner.<br /><em></em></p><p><em>Learning Objectives</em>: the physician audience should be able to: Describe the purpose of regular Diabetes Maintenance Visits; List the main elements to be covered in a Diabetes Maintenance Visit; and Cover the elements in a time-efficient, yet patient-centered manner</p><p><em>Podcast Pearl: </em>Level of service for diabetes/chronic disease maintenance visits (Dr. Mary Spalding)</p><p>There is also a Fact Sheet at: <a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMOfficeVisit.pdf" target="_blank"></a><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMOfficeVisit.pdf" target="_blank"><a href="http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMOfficeVisit.pdf" target="_blank">http://www.ttuhsc.edu/som/fammed/ttmedcast/PodcastEpisodeFS_DMOfficeVisit.pdf</a></a></p>Wed, 08 Apr 2009 02:39:36 GMTOscar Noriega; Mary Spalding Texas Tech Medical School; Texas Tech Medical School